A precarização jurídica das relações de trabalho como fator de sofrimento das(os) trabalhadoras(es) no setor da saúde durante a pandemia de COVID-19 / The legal precariousness of work relations in the health sector during the COVID-19 pandemic, as a factor of worker suffering

Resumo O artigo analisou o processo de precarização das relações de trabalho no setor da saúde, demonstrando como essa situação gerou sofrimento dos trabalhadores. O texto buscou registrar como a adoção institucional das concepções econômicas neoliberais, de redução das políticas sociais de Estado, acopladas a um histórico de rejeição cultural aos direitos trabalhistas, proporcionou a atração dos mecanismos de precarização do trabalho, notadamente, a terceirização da mão de obra e da prestação de serviços. No segundo momento, o texto aponta as impropriedades jurídicas cometidas, apresentando as consequências da fragilização do vínculo jurídico nas condições de trabalho desses trabalhadores, principalmente no que se refere às jornadas de trabalho e a remuneração, destacando-se, também, o quanto a disseminação desses vínculos representou um fator de rebaixamento geral dos salários e direitos trabalhistas e previdenciários no setor. Foram apresentados, ainda, dados das pesquisas da Fiocruz sobre condições de trabalho durante a pandemia. Conclui mostrando a urgência de se resgatarem os institutos jurídicos trabalhistas que foram abandonados no percurso histórico estudado, para direcionar a novo rumo as políticas públicas na saúde.

Abstract The present article analyzed the process of precarious work relations in the health sector, demonstrating how this situation generated illness and suffering among workers. The text sought to register how the institutional adoption of neoliberal economic conceptions, of the reduction of State social policies, coupled with a history of cultural rejection of labor rights, provided the attraction of mechanisms of precarious work for the public sector, notably, the outsourcing of labor and the provision of services. In a second moment, the text points out the legal improprieties committed, presenting the consequences of the weakening of the legal bond in the working conditions of these workers, mainly regarding working hours and remuneration, also highlighting how much the dissemination of these links represented a factor of a general reduction in wages and labor and social security rights in the sector. Data from Fiocruz surveys on working conditions during the pandemic were also presented. The article concludes by showing the urgency of rescuing the legal labor institutes that were abandoned in the historical path studied in order to guide the public health policies in a new direction.

Bluetongue disease in sheep: a review / O vírus da língua azul em ovinos: uma revisão

The present review aims to show the main aspects related to bluetongue virus (BTV) infection in sheep. The bluetongue (BT) is a viral, infectious, and non-contagious disease caused by a virus (BTV) of the Orbivirus genus, transmited by a hematophagous vector of the Culicoides genus, to domestic and wild ruminants, mainly to sheep, the most susceptible species. It is caused by the association of endemic with climate conditions, with high temperatures and humidity. Economic loss is directly linked to death, abortion, weight loss, loss of milk, and meat production, and, indirectly, to the restriction on the export of animals and their by-products. The study concludes that the BTV is worldwidely spread, and probably persists due to the warm and humid climate that leads to the proliferation of Culicoides sp., being necessary to adopt measures that reduce the risk factors associated to the BTV infection.(AU)

A presente revisão objetivou apresentar os principais aspectos relacionados à infecção causada pelo vírus da língua azul em ovinos. A língua azul é uma doença viral, infecciosa e não contagiosa, causada por um vírus (BTV) do gênero Orbivírus, transmitida por meio de vetores hematófagos do gênero Culicoides a ruminantes domésticos e selvagens, principalmente aos ovinos, a espécie mais susceptível. A infecção ocorre de forma endêmica, associada a condições climáticas com elevada temperatura e umidade. As perdas econômicas estão ligadas diretamente à morte, ao abortamento, à perda de peso, à perda na produção de leite e carne, e, indiretamente, devido à restrição na exportação de animais e seus subprodutos. O estudo conclui que a língua azul está disseminada mundialmente e persiste, provavelmente, devido ao clima quente e úmido que propicia a proliferação de Culicoides sp., sendo necessário adotar medidas que diminuam os fatores de risco associados à infecção pelo vírus.(AU)

Cáncer de laringe y sinunasal en Cali, Colombia 1962 ­ 2015 / Sinonasal and laryngeal carcinoma in Cali, Colombia 1962 ­ 2015

Introducción: El cáncer es una enfermedad de alta incidencia, con múltiples factores etiológicos y diferentes características evolutivas. Objetivo: Describir la supervivencia y la tendencia de las tasas de incidencia y mortalidad por cáncer de laringe y senos paranasales en Cali (Colombia) durante el periodo 1962 a 2015. Diseño: Estudio observacional descriptivo. Métodos: La información de incidencia, durante el periodo 1962 a 2012, se obtuvo en el RPCC y la mortalidad entre 1984-2015 de la SSPM. El comportamiento de la tendencia se evaluó con el porcentaje de cambio anual (APC) y la supervivencia relativa se estimó con el método de Ederer II. La estadificación se realizó con la AJCC. Resultados: Durante 1962 a 2012, se diagnosticaron 1623 casos nuevos de cáncer, 85.2% (1383 casos) fueron de laringe y 14.8% (240 casos) sinunasal 76% fueron hombres y el CCE fue el tipo histológico más frecuente 84.1% y 59.6% en laringe y sinunasal respectivamente. Se observó una disminución significativa del riesgo de cáncer de laringe en ambos sexos, siendo mayor la disminución en hombres (APC=-1,1*(ICD95%: -1,6; -0,7)). La disminución en la tasa de incidencia de cáncer de laringe CEC fue mayor en hombres (APC=-1,1*(ICD95%: -1,6; -0,6)) durante 1962-2012. Las tasas de mortalidad disminuyeron significativamente (APC=- 2,5*(ICD95%:-3,6 -1,5)). La supervivencia relativa a 5 años durante el periodo 2008- 2012, 43,5%; 93 pacientes se estadificaron con supervivencia: T3-T4 (41,5%) y T1- T2 (55,0%). Conclusiones: El riesgo del cáncer de laringe y sinunasal escamocelular asociado al tabaquismo disminuyó de manera significativa en hombres y mujeres de Cali durante los últimos 53 años.

Introduction: Cancer is disease with high incidence, multiple etiological factors and different characteristics. Objective: To describe the survival and trend of the incidence and mortality rates for cancer of the larynx and paranasal sinuses in Cali (Colombia) during the period 1962 to 2015. Design: Descriptive observational study. Methods: Incidence information, during the period 1962 to 2012, was obtained in the RPCC and mortality between 1984-2015 of the SSPM. The behavior of the trend was evaluated with the percentage of annual change (APC) and the relative survival was estimated with the method of Ederer II. The arrangement was made with the AJCC. Results: During 1962 to 2012, 1623 new cases of cancer were diagnosed, 85.2% (1383 cases) were laryngeal and 14.8% (240 cases) sinunasal 76% were men and the CCE was the most frequent histological type 84.1% and 59.6% in larynx and sinunasal respectively. A significant decrease in the risk of laryngeal cancer was observed in both sexes, with a greater decrease in men (APC = -1.1 * (ICD95%: -1.6, -0.7)). The decrease in the incidence rate of laryngeal cancer CEC was higher in men (APC = -1.1 * (ICD95%: -1.6, -0.6)) during 1962-2012. Mortality rates decreased significantly (APC = -2.5 * (ICD95%: - 3.6 -1.5)). The 5-year relative survival rate during the period 2008-2012 was 43.5%; 93 patients were stratified with survival: T3-T4 (41.5%) and T1-T2 (55.0%). Conclusions: The risk of laryngeal and squamous cell sinonasal cancer associated to smoking decreased significantly in men and women of Cali during the last 53 years.

¿Cómo seleccionar el paciente candidato a cirugía estética facial y qué hacer ante un paciente insatisfecho? / How to select the adequate patient for a aesthetic facial surgery and what to do when facing a dissatisfied one?

Objetivo: Este artículo pretende dar a conocer aspectos importantes para la selección del paciente candidato a cirugía estética facial y cómo actuar en caso de insatisfacción. Diseño: Revisión narrativa de la literatura. Métodos: Revisión narrativa de la literatura que resume aspectos relevantes en la relación médico paciente y los factores en la selección y el manejo de los pacientes candidatos a cirugía plástica facial. Conclusión: El objetivo de la cirugía estética facial es satisfacer al paciente para generar el cambio deseado tanto físico como funcional. Muchas veces los objetivos, las motivaciones y las expectativas de los pacientes son complejas, y para satisfacerlas es necesario determinar aspectos psicológicos de cada uno de ellos y mantener una relación médico - paciente basada en la comunicación y cordialidad, con el fin de evitar daño físico, emocional y económico, e identificar como actuar en caso de enfrentar un paciente insatisfecho.

Objective: This article seeks to show the most important aspects for the selection of adequate patients for aesthetic facial surgery and to give recommendations on how to approach and manage patients that are not satisfied with their procedures. Design: Narrative Review. Methods: Narrative review of the literature summarizing relevant aspects of the doctor-patient relationship and factors in the selection and management of patients candidates for facial plastic surgery. Conclusion: The objective of aesthetic facial surgery is to be able to satisfy the patient generating the physical and functional changes that he or she wishes. The are many cases where the objectives, motivations and expectations from patients are very complex and in order to fulfill them it is necessary to determine the psychological aspects from each one of them individually. Maintaining a doctor-patient relationship based in communication and cordiality is very important, in order to avoid physical, emotional and economic harm and to be able to know how to react and manage patients in case of dissatisfaction.

Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling / Impacto da Ablação da Fibrilação Atrial na Pressão de Enchimento Ventricular Esquerdo e Remodelamento Atrial Esquerdo

Background: Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective: To evaluate the impact of AF ablation on estimated LV filling pressure. Methods: A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results: One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001) compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Conclusion: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure. .

Fundamento: A disfunção diastólica do ventrículo esquerdo (VE) está associada a novos episódios de fibrilação atrial (FA), e a estimativa das pressões de enchimento do VE através da razão E/e' está relacionada a um pior prognóstico em pacientes com FA. Entretanto, não se sabe se a restauração do ritmo sinusal pode reverter este processo. Objetivo: Avaliar o impacto da ablação da FA na estimativa da pressão de enchimento do VE. Métodos: Um total de 141 pacientes foi submetido à ablação por radiofrequência (RF) para o tratamento da FA refratária a drogas. Foi realizado ecocardiograma transtorácico 30 dias antes e 12 meses após a ablação. Foram avaliados os parâmetros funcionais do VE, volume do átrio esquerdo indexado (VAEi) e Doppler transmitral pulsado e Doppler tecidual do anel mitral (e' e E/e'). Dezoito pacientes apresentavam FA paroxística, 102 persistente e 21 pacientes FA persistente de longa duração. O acompanhamento incluiu ECG e monitoramento pelo sistema Holter 24h, 3, 6 e 12 meses após a ablação. Resultados: Cento e dezessete pacientes (82,9%) não apresentaram FA durante o acompanhamento (média de 18 meses ± 5 meses). O VAEi apresentou redução significativa no grupo com sucesso (30,2 mL/m2 ± 10,6 mL/m2 para 22,6 mL/m2 ± 1,1 mL/m2, p < 0,001) em comparação ao grupo sem sucesso (37,7 mL/m2 ± 14,3 mL/m2 para 37,5 mL/m2 ± 14,5 mL/m2, p = ns). A melhora da estimativa da pressão de enchimento do VE, avaliada através da redução na razão E/e', foi observada apenas após ablação com sucesso (11,5 ± 4,5 vs. 7,1 ± 3,7, p < 0,001), não sendo observada em pacientes com FA recorrente (12,7 ± 4,4 vs. 12 ± 3,3, p = ns). A taxa de ...

Nueva técnica para rinoplastia definitiva en labio y paladar hendido / Do not build on weak: A new definitive cleft rhinoplasty technique

El labio y el paladar hendidos son deformidades congénitas frecuentes, con una incidencia de 1:700. La deformidad nasal hendida presenta defectos óseos, cartilaginosos y cutáneos, separándola en dificultad de otras rinoplastias cosméticas. Los cartílagos laterales inferiores (LLC) son asimétricos; el de la hendidura presenta una crura medial corta, una crura lateral larga-débil y un domo hipoproyectado. La técnica clásica intenta convertir el cartílago alar de la hendidura en uno sano, avanzando la crura medial y realizando una lateralización del domo, modificaciones soportadas por el LLC sano. Esta tensión, que no es inocua, genera una gran carga, con resultados asimétricos y poco naturales. Nuestra técnica se enfoca en el LLC sano. Se dividen las cruras medial y lateral; se realiza una sutura de sobreposición, creando un cartílago lateral inferior fuerte con las dimensiones del LLC hendido. Los cartílagos idénticos distribuyen las fuerzas de forma simétrica, eliminando el desequilibrio y la tensión de la técnica clásica. Un poste columelar y un escudo brindan soporte y proyección. Una excelente rotación, proyección, definición y simetría de la punta han sido logradas de manera consistente en más de 30 casos. Nuestra técnica es simple, confiable y reproducible para corregir la deformidad nasal en el labio y el paladar hendido...

Cleft lip and palate are common congenital deformities with an incidence of 1:700. Cleft noses have abnormalities in all tissue layers separating them in kind and difficulty from most cosmetic rhinoplasties. Lower lateral cartilages (LLC) are asymmetric; the cleft’s side has short medial crus and long-weak lateral crus. The cleft’s dome being retro-displaced. Classical definite rhinoplasty tries to make the cleft’s lower lateral cartilage as similar as possible to the healthy side. Advancing the medial crus and performing a lateral crural steal. All these changes will be supported by the healthy LLC. These maneuvers are not innocuous; generate a burden that leads to asymmetric and unnatural outcomes. Our approach focuses on the healthy LLC, building the strongest tripod possible. Medial and lateral crural divisions followed by an overlay suture, create a strong LLC with the dimensions of the cleft’s LLC. Identical cartilages will distribute forces equally. A columellar strut and a shield tip graft will add support and projection. Consistent improvement in rotation, projection, tip definition and symmetry has been achieved in more than 30 cases. No structure is responsible for retaining other; this is a simple, reliable and reproducible technique for correction of the cleft nose deformity...

Baixa concordância entre diâmetro e volume do átrio esquerdo em pacientres com maior risco de fibrilação atrial / Low agreement between left atrial diameter and volume in patients with increased risk of atrial fibrillation

Introdução: O aumento do átrio esquerdo (AE) está diretamente relacionado a disfunção diastólica do VE(VD) e ambos estão associados a ocorrência de fibrilação atrial (FA). Embora o diâmetro (DAE) seja mundialmente usado como medida do AE, muitas evidencias mostram que o volume indexado para a superficie corporea (indVAE) é mais acurado. Objetivo: Avaliar a correlação entre DAE e IndVAE em pacientes (pt) com DD. Material e Métodos: Dentre 892 pacientes encaminhados ao ecocardiograma, (ECO) de uma clínica terciaria no DF, entre janeiro de 2008 a junho de 2009, foram selecionados 540 com addos clínicos e ecocardiograficos, dos quais foram excluidos 21, devido a idade < 18 anos e 18 pacientes com lesão valvar mitral > discreta. A função diastólica foi considerada, significativamente, anormal se E/e'>-15 (elevação das pressões de encihmento ventricular esquerdo). A concordância entre as medidas de DAE e IndVAE foi avaliada da seguinte forma concordante (IndVAE<- 40mm ou IndVAE > 40); e discordante (indVAE<- 32 e DAE > 40 ou IndVAE > 32 e DAE <- 40.). Resultados: Dos 501 pacientes estudados, 33 (6,6%) tinham E/e' >- 15 e 468 (93,4%) E/e' < 15. Houve boa correlação entre DAE e IndVAE tanto para pacientes com E/e' >- 15 (r=0,57), quando para pacientes com E/e' < 15 (r=0,62). A discordância entre DAF e IndVAE foi maior nos pacientes...

Background: Increased left atrial (LA) is directly related to LV diastolic dysfunction (DD), and both are associated with atrial fibrillation (AF). Although the diameter (LAD) is used as a measure of LA, many evidences show that LA volume index (iLAV) is more accurate. Objective: To evaluate the correlation between LAD and iLAV in patients (pt) with DD. Material and Methods: Among 892 pt referred to the echocardiography laboratory of a tertiary clinic, from Jan/08 to June/09, 540 pt with clinical and echocardiographic data were selected and 21 were excluded for being <18yo and 18 pt presenting more than mild mitral valve lesion. Diastolic function was considered abnormal when E/e¡¯ ratio ¡Ý 15 (elevated left ventricular filling pressures). Agreement between measures of LAD and iLAV was evaluated: agreement if iLAV ¡Ü 32ml/m2 and LAD ¡Ü 40mm or iLAV > 32 and LAD > 40; and disagreement if iLAV ¡Ü 32 and LAD > 40 or iLAV > 32 and LAD ¡Ü 40. Results: Of 501 pt, 33 (6.6%) presented E/e¡¯ ratio ¡Ý 15 and 468 (93.4%) < 15. There was a good correlation between LAD and iLAV in both patients with E/e¡¯ ¡Ý 15 (r = 0.57), and E/e¡¯ < 15 (r = 0.62). The disagreement between LAD and iLAV was higher in p with E/e¡¯ ¡Ý 15 (21.2% vs 9% - p <0.0001). Clinical and echocardiographic data were, respectively, for E/e¡¯ ¡Ý15 and E/e¡¯ < 15: male 54.5% vs 45.5% (p = ns), age 73.2 ¡À 12.4 vs 50.1 ¡À 16.5 (p <0.0001), LAD (cm) 38.8 ¡À 6.3 vs 35.2 ¡À 5.2 (p <0.0001); iLAV (ml/m2) 35 ¡À 16.2 x 21.9 ¡À 7 (p <0.0001), EF (%) 60.7 ¡À 16.2 vs 70.7 ¡À 6.9 (p <0.0001), E/e¡¯ 21 , 1 ¡À 8.1 vs 16.5 ¡À 2.4 (p <0.0001), HBP 81.8% vs. 50.2% (p <0.0001), DM 21.2% vs. 9.4% (p = 0.04); CHF 24.2% vs. 3.2% (p <0.0001), CAD 33.3% versus 9% (p <0.0001). Conclusion: Patients with elevated left ventricular filling pressures are older, have larger LA diameter and volume, worse EF and higher incidence of HBP, diabetes, CHF and CAD. There is less agreement between LAD and iLAV in these patients.

An easy and efficient strategy for KEL genotyping in a multiethnic population

BACKGROUND: The Kell blood group system expresses high and low frequency antigens with the most important in relation to transfusion including the antithetic KEL1 and KEL2; KEL3 and KEL4; KEL6 and KEL7 antigens. Kell is a clinically relevant system, as it is highly immunogenic and anti-KEL antibodies are associated with hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. Although required in some situations, Kell antigen phenotyping is restricted due to technical limitations. In these cases, molecular approaches maybe a solution. This study proposes three polymerase chain reaction genotyping protocols to analyze the single nucleotide polymorphisms responsible for six Kell antithetic antigens expressed in a Brazilian population. METHODS: DNA was extracted from 800 blood donor samples and three polymerase chain reaction-restriction fragment length polymorphism protocols were used to genotype the KEL*1/KEL*2, KEL*3/KEL*4 and KEL*6/KEL*7 alleles. KEL*3/KEL*4 and KEL*6/KEL*7 genotyping was standardized using the NlaIII and MnlI restriction enzymes and validated using sequencing. KEL*1/KEL*2 genotyping was performed using a previously reported assay. RESULTS: KEL genotyping was successfully implemented in the service; the following distribution of KEL alleles was obtained for a population from southeastern Brazil: KEL*1 (2.2%), KEL*2 (97.8%), KEL*3 (0.69%), KEL*4 (99.31%), KEL*6 (2.69%) and KEL*7 (97.31%). Additionally, two individuals with rare genotypes, KEL*1/KEL*1 and KEL*3/KEL*3, were identified. CONCLUSION: KEL allele genotyping using these methods proved to be reliable and applicable to predict Kell antigen expressions in a Brazilian cohort. This easy and efficient strategy can be employed to provide safer transfusions and to help in rare donor screening.

Chance matemática na determinação do estado nutricional do amendoim / Mathematical chance in determination of nutritional status of peanut

Na literatura, são escassas informações a cerca da avaliação nutricional para a maioria das culturas, em especial o amendoim. Objetivou-se avaliar o estado nutricional do amendoim cultivar BR-1, através da chance matemática. O experimento foi conduzido em Fortaleza-CE, no período de agosto a dezembro de 2009. As plantas foram cultivadas em canteiros, adubados com N (3, 21, 30, 39 e 57 kg ha-1), P2O5 (7, 46, 65, 85 e 124 kg ha-1) e K2O (5, 32, 45, 59 e 86 kg ha-1), sendo composto por dezesseis tratamentos conforme a matriz Plan Puebla III e quatro repetições. Durante o período de florescimento foi coletada folhas para a determinação dos teores de NPK. Utilizou-se a ChM matemática para fazer a diagnose foliar. Para N, as maiores chances matemáticas para obtenção de altas produtividades ocorreram com teores de N na faixa de 31,11 a 40,23 g kg-1, para P, de 1,66 a 2,11 g kg-1 e para K entre 13,42 a 18,15 g kg-1. Pela ChM, estimou-se que os teores de 35,67; 1,89 e 15,78 g kg -1 de N; P e K, respectivamente, como sendo os teores ótimos para a cultura. O método mostra-se promissor para determinar a faixa de suficiência e nível crítico para a cultura do amendoim cultivar BR-1.

In the literature, there is little information about the nutritional assessment for most crops, especially peanut. Therefore, the objective of this study was to evaluate the nutritional status of the peanut cultivar BR-1, by the method of mathematical chance (ChM). The experiment was conducted in Fortaleza-CE, from August to December 2009. Plants were grown in beds, fertilized with N (3, 21, 30, 39 and 57 kg ha-1), P2O5 (7, 46, 65, 85 and 124 kg ha-1) and K2O (5, 32, 45, 59 e 86 kg ha-1), comprising sixteen treatment as the matrix Plan Puebla III, with four replications. During the flowering period leaves were collected to determine the levels of NPK. The method of mathematical chance was used to make the leaf diagnosis. The greatest mathematical chance to obtain high yields occurred at contents from 31.11 to 40.23 g kg-1 for N; 1.66 to 2.11 g kg-1 for P and 13.42 to 18.15 g kg-1 for K. By the method of ChM, it was estimated that the levels of 35.67, 1.89 and 15.78 g kg-1 of N, P and K, respectively, were the optimum levels for the crop. The method shows promise for determining the sufficiency range and critical level for the peanut crop cultivar BR-1.

Fatores associados ao abandono do tratamento da tuberculose nos serviços de atenção básica em dois municípios brasileiros, Manaus e Fortaleza, 2006 a 2008 / Factors associated with noncompliance with tuberculosis treatment in primary care services in two Brazilian cities, Manaus and Fortaleza, from 2006 to 2008

O estudo procurou identificar os fatores de risco para o abandono de tratamento da tuberculose no cenário da atenção básica de saúde e avaliar a influência da distância entre o local de atendimento e a residência dos pacientes no abandono do tratamento. Realizou-se um estudo caso-controle com casos novos de tuberculose, tratados no período de 2006 a 2008, nos municípios de Manaus (AM) e Fortaleza (CE). Foram entrevistados 434 indivíduos (92 casos e 342 controles) com questionário estruturado pré-codificado. Estudaram-se os fatores: sexo, anos de estudo, renda, classe econômica, distância entre a unidade de atendimento e a residência, uso de drogas ilícitas, alcoolismo, tabagismo, hospitalização e infecção por vírus da imunodeficiência humana (HIV). O uso de drogas ilícitas apresentou a mais forte associação (risco 2,5 vezes maior), seguido de mais baixa classe econômica e ser do sexo masculino. A construção parcimoniosa do modelo utilizado permitiu identificar que ainda permanecem, como principais fatores de risco, aqueles que representam situações críticas como a drogadição. A situação econômica parece ter importância, não obstante a adoção de tratamento gratuito e universalizado. A condição de ser do sexo masculino permaneceu associada ao abandono, mesmo quando retirado o efeito dos demais cofatores. Avaliou-se a distância entre a residência do paciente e o serviço de saúde e não foi detectada diferença significativa dessas distâncias para casos e controles.

Magnetic bead technology for viral RNA extraction from serum in blood bank screening

Nucleic acid amplification testing (NAT) was recently recommended by Brazilian legislation and has been implemented at some blood banks in the city of São Paulo, Brazil, in an attempt to reduce blood-born transmission of human immunodeficiency virus (HIV) and hepatitis C virus. OBJECTIVE: Manual magnetic particle-based extraction methods for HIV and HCV viral nucleic acids were evaluated in combination with detection by reverse transcriptase - polymerase chain reaction (RT-PCR) one-step. METHODS: Blood donor samples were collected from January 2010 to September 2010, and minipools of them were submitted to testing. ELISA was used for the analysis of anti-HCV/HIV antibodies. Detection and amplification of viral RNA was performed using real-time PCR. RESULTS: Out of 20.808 samples screened, 53 samples (29 for HCV and 24 for HIV) were confirmed as positive by serological and NAT methods. CONCLUSION: The manual magnetic bead-based extraction in combination with real-time PCR detection can be used to routinely screen blood donation for viremic donors to further increase the safety of blood products.